Stroke Secondary to Neurosyphilitic Vasculitis in an HIV/AIDS Patient (P01.251)

Abstract

Objective: To describe a case of CNS Syphilis as a cause of large-vessel stroke in a newly-diagnosed HIV/AIDS patient. Background Occlusive vessel disease in young patients is usually secondary to hypercoagulability risk factors. However, CNS infections (including viral, bacterial, fungal, spirochete) can also present with similar findings. If not correctly identified and treated, such infections lead to significant morbidity and mortality. CNS syphilis has been associated with perivascular inflammation, cerebrovascular thrombosis, vessel occlusion, ischemia and infarction. Here we report the successful and timely treatment of a young patient who presented with a large vessel stroke, with eventual diagnosis of CNS syphilis. Design/Methods: Case Report. Results: A 33-year old man with recent diagnosis of HIV/AIDS presented to the emergency department with a 2-month history of personality change, depression, and new-onset syncope. Examination revealed fluctuating mental state, left-sided weakness, left hemi-neglect and right-gaze deviation. MRI brain revealed a right MCA distribution infarct. MRA revealed complete occlusion of the right MCA, and stenosis of the right proximal ICA. Laboratory examination revealed a low CD4 count of 42, HIV viral load of ∼1 million copies, positive serum RPR, elevated ESR (141 mm/hr) and CRP (3.4). CSF studies revealed 2 WBC, 10 RBC, normal glucose, and elevated protein. CSF VDRL and FTA tests were positive. A diagnosis of neurosyphilitic vasculitis was made. Upon treatment with Penicillin G for 14 days, the patient9s symptoms improved significantly. Conclusions: Here we present a case of a young man without any hypercoagulability risk factors, with HIV/AIDS, with occlusive large vessel infarcts secondary to syphilitic infection. Our case highlights the need for detailed evaluation of etiologies underlying large vessel strokes (including CSF), when such unusual stroke findings are present, so that appropriate and early treatment can be initiated. Disclosure: Dr. Rickard has nothing to disclose. Dr. Iyadurai has nothing to disclose.